INCOME GROUP PERSONAL MEDICAL INSURANCE

PRELIMINARY REPORT: APRIL 2009 - AUGUST 2010 National Infl ammatory Arthritis Registry NIAR 19 The percentage of pa ents fulfi lling the 1987 ACR criteria is shown in Figure 9. 78.3 fulfi ll the ACR criteria defi ni on for Rheumatoid Arthri s however a signifi cant propor on fulfi ll less than 4 of the criteria. 5 10 15 20 25 30 35 4 22.5 34 1.8 20 5 6 7 21.7 78.3 ≥ 4 ≥ 4 o f p a e n ts Number of ACR Criteria fulfi lled Figure 9: Percentage of pa ents fulfi lling ACR criteria

3.2 DURATION OF DISEASE BEFORE DIAGNOSIS

Almost half of the pa ents were diagnosed late, that is more than a year a er the onset of symptoms. However, a signifi cant propor on of pa ents were diagnosed between 1 to 6 months from symptom onset. 10 20 30 40 50 37.3 6 months 6 months 12 months 14 48.7 Number of months from symptom onset to diagnosis Figure 10: Distribu on of pa ents according to dura on of disease before diagnosis PRELIMINARY REPORT: APRIL 2009 - AUGUST 2010 National Infl ammatory Arthritis Registry NIAR 20 Comparing professionals and non-professionals, it would appear that more professionals are diagnosed earlier, that is less than 6 months from disease onset. However, even amongst the professionals, about 40 were diagnosed more than a year from the onset of symptoms. 12 months 6 to 12 months 6 months 20 40 60 80 100 120 N=102 40.2 15.59

44.11 49.67

13.81 36.52 Professional Non-Professional N=898 Figure 11: Dura on of disease before diagnosis comparing professionals and non-professionals 3.3 ASSOCIATED MEDICAL PROBLEMS 3.3.1 MEDICAL CO-MORBIDITIES Among the medical condi ons, hypertension was the commonest co- morbidity with a prevalence of 36.2. This is slightly lower than the na onal prevalence of 42.6 of hypertension in adults above 30 years of age 5. Next was hyperlipidaemia at 25.5 followed by diabetes at 16.1. The Na onal Health and Morbidity Survey in 2006 found that the prevalence of diabetes is 12 6. 6.1 of pa ents had been diagnosed to have osteoporosis. Pep c ulcer disease and ischaemic heart disease were each reported in 3.9 of the pa ents. The other medical condi ons with the reported fi gures are listed in Table 4. PRELIMINARY REPORT: APRIL 2009 - AUGUST 2010 National Infl ammatory Arthritis Registry NIAR 21 5 10 15 20 25 30 35 40 3.9 IHD PUD Osteoporosis DM Hyperlipidaemia Hypertension 3.9 6.7 16.1 25.5 36.2 Figure 12: Associated co-morbidi es Disease of pa Ɵ ents Fa y liver 2.3 Tuberculosis 1.2 Hepa s B 1.0 Stroke 0.6 Renal impairment 0.5 Hepa s C 0.2 Others 20.4 Table 4: Associated co-morbidi es

3.3.2 MALIGNANCIES

16 cases of malignancies were reported. The highest malignancy reported was breast cancer. The other malignancies to fi nd out what the other malignancies are 4 other malignancies includes - kidney, brain, thyroid colon cancer

3.4 EXTRAARTICULAR MANIFESTATIONS

There are a number of extraar cular manifesta ons associated with Rheumatoid Arthri s. The commonest one seen in this pa ent cohort was keratoconjunc vi s sicca followed by lung fi brosis and anaemia due to rheumatoid arthri s. 35 PRELIMINARY REPORT: APRIL 2009 - AUGUST 2010 National Infl ammatory Arthritis Registry NIAR 22 pa ents had rheumatoid nodules. The percentages of pa ents with each extraar cular manifesta ons are listed below. Manifesta Ɵ on Numbers Percentage Keratoconjunc vi s sicca 226 22.6 Inters al lung disease 61 6.1 Anaemia due to RA disease ac vity 37 3.7 Rheumatoid nodules 61 6.1 Eye infl amma on 8 0.8 Fever 5 0.5 Raynaud’s 4 0.4 Entrapment neuropathy 4 0.4 Atlanto-axial subluxa on 4 0.4 Cutaneous vasculi s 3 0.3 Mononeuropathy 2 0.2 Polyneuropathy 1 0.1 Felty’s syndrome 1 0.1 Cervical myelopathy 1 0.1 Pleural e ff usion Pericardi se ff usion Amyloidosis Lymphadenopathy Others 9 0.9 Table 5: Extraar cular manifesta ons

3.5 DISEASE STATUS AT 1ST NOTIFICATION

The DAS28 score is used to assess pa ent’s disease ac vity. The DAS28 score is calculated based on the number of swollen and tender joints only 28 joints are assessed, general health assessment using a pa ent visual analogue scale and either ESR or CRP. Pa ents are then categorized into either having low DAS28 2.6 to 3.2, moderate DAS28 3.2 to 5.1 or high DAS28 5.1 disease ac vity states or in remission DAS29 2.6. Those whose DAS28 scores cannot be obtained for various reasons were classifi ed as unknown. Nearly half of the pa ents in this cohort were in the moderate and high disease categories.